Nav: Home

Making weight: Ensuring that micro preemies gain pounds and inches

August 10, 2018

A quality-improvement project to standardize feeding practices for micro preemies--preterm infants born months before their due date-- helped to boost their weight and nearly quadrupled the frequency of lactation consultations ordered in the neonatal intensive care unit (NICU), a multidisciplinary team from Children's National Health System finds.

According to the Centers for Disease Control and Prevention, about 1 in 10 infants in 2016 was preterm, born prior to completing 37 gestational weeks of pregnancy. Micro preemies are the tiniest infants in that group, weighing less than 1,500 grams and born well before their brain, lungs and organs like the liver are fully developed.

As staff reviewed charts for very low birth weight preterm infants admitted to Children's NICU, they found dramatic variation in nutritional practices among clinicians and a mean decline in delta weight Z-scores, a more sensitive way to monitor infants' weight gain along growth percentiles for their gestational age. A multidisciplinary team that included dietitians, nurses, neonatologists, a lactation consultant and a quality-improvement leader evaluated nutrition practices and determined key drivers for improving nutrition status.

"We tested a variety of strategies, including standardizing feeding practices; maximizing intended delivery of feeds; tracking adequacy of calorie, protein and micronutrient intake; and maximizing use of the mother's own breast milk," says Michelande Ridoré, MS, a Children's NICU quality-improvement lead who will present the group's findings during the Virginia Neonatal Nutrition Association conference this fall. "We took nothing for granted: We reeducated everyone in the NICU about the importance of the standardized feeding protocol. We shared information about whether infants were attaining growth targets during daily rounds. And we used an infographic to help nursing moms increase the available supply of breastmilk," Ridoré says.

On top of other challenges, very low birth weight preterm infants are born very lean, with minimal muscle. During the third trimester, pregnant women pass on a host of essential nutrients and proteins to help satisfy the needs of the fetus' developing muscles, bones and brain. "Because preterm infants miss out on that period in utero, we add fortification to provide preemies with extra protein, phosphorus, calcium and zinc they otherwise would have received from mom in the womb," says Victoria Catalano, RDN, LD, CNSC, CLC, a pediatric clinical dietitian in Children's NICU and study co-author. Babies' linear growth is closely related to neurocognitive development, Catalano says. A dedicated R.N. is assigned to length boards for Children's highest-risk newborns to ensure consistency in measurements.

Infants who were admitted within the first seven days of life and weighed less than 1,500 grams were included in the study. At the beginning of the quality-improvement project, the infants' mean delta Z-score for weight was -1.8. By December 2018, that had improved to -1.3. And the number of lactation consultation ordered weekly increased from 1.1 to four.

"We saw marked improvement in micro preemies' nutritional status as we reduced the degree of variation in nutrition practices," says Mary Revenis, M.D., NICU medical lead on nutrition and senior author for the research. "Our goal was to increase mean delta Z-scores even more. To that end, we will continue to test other key drivers for improved weight gain, including zinc supplementation, updating infants' growth trajectories in the electronic medical record and advocating for expanded use of birth mothers' breast milk," Dr. Revenis says.
-end-
In addition to Ridoré, Catalano and Dr. Revenis, study co-authors include Caitlin Forsythe MS, BSN, RNC-NIC, lead author; Rebecca Vander Veer RD, LD, CNSC, CLC, pediatric dietitian specialist; Erin Fauer RDN, LD, CNSC, CLC, pediatric dietitian specialist; Judith Campbell, RN, IBCLC, NICU lactation consultant; Eresha Bluth MHA; Anna Penn M.D., Ph.D., neonatalogist; and Lamia Soghier M.D., Med., NICU medical unit director.

Children's National Health System

Related Nutrition Articles:

Learning about nutrition from 'food porn' and online quizzes
Harvard and Columbia researchers designed an online experiment to test how people learn about nutrition in the context of a social, online quiz.
4 exciting advances in food and nutrition research
New discoveries tied to how food affects our body and why we make certain food choices could help inform nutrition plans and policies that encourage healthy food choices.
Cutting-edge analytics allows health to be improved through nutrition
The company Lipigenia, which specializes in setting out guidelines on appropriate nutrition to achieve people's well-being on the basis of state-of-the-art blood analytics, has embarked on its activity following the partnership reached between AZTI, the Italian enterprise CNR-ISOF and Intermedical Solutions Worldwide.
Nothing fishy about better nutrition for mums and babies
Researchers from the South Australian Health and Medical Research Institute (SAHMRI) and the University of Adelaide have found a way to provide mothers and young children in Cambodia with better nutrition through an unlikely source -- fish sauce.
Nutrition information... for cows?
Cattle need a mixture is legume and grass for a healthy, balanced diet.
Analyzing picture books for nutrition education
Feeding children can be a challenging process for many parents.
Researchers develop new framework for human nutrition
Existing models for measuring health impacts of the human diet are limiting our capacity to solve obesity and its related health problems, claim two of the world's leading nutritional scientists in their newest research.
Nutrition labels on dining hall food: Are they being used? By who?
University of Illinois dining halls voluntarily label foods with nutrition information.
Children's nutrition influenced by local neighborhoods
In an innovative study, Dr. Gilliland and his team used GPS technology to provide evidence that adolescents' exposure to junk food outlets during trips to and from school affects their likelihood of making a junk food purchase.
Leading nutrition experts speak up about malnutrition
Malnutrition is a critical public health problem, affecting many people across the United States and around the world.

Related Nutrition Reading:

How Not to Die: Discover the Foods Scientifically Proven to Prevent and Reverse Disease
by Michael Greger M.D. (Author), Gene Stone (Author)

Academy of Nutrition and Dietetics Complete Food and Nutrition Guide, 5th Ed
by Roberta Larson Duyff (Author)

Whole: Rethinking the Science of Nutrition
by T. Colin Campbell (Author), Howard Jacobson (Contributor)

Deep Nutrition: Why Your Genes Need Traditional Food
by Catherine Shanahan M.D. (Author)

Nutrition For Dummies
by Carol Ann Rinzler (Author)

Nutrition: Concepts and Controversies - Standalone book
by Frances Sizer (Author), Ellie Whitney (Author)

Essential Sports Nutrition: A Guide to Optimal Performance for Every Active Person
by Marni Sumbal MS RD CSSD (Author)

Understanding Nutrition
by Eleanor Noss Whitney (Author), Sharon Rady Rolfes (Author)

Nancy Clark's Sports Nutrition Guidebook
by Nancy Clark (Author)

Nutrition: Concepts and Controversies, 13th Edition
by Frances Sienkiewicz Sizer (Author), Ellie Whitney (Author)

Best Science Podcasts 2018

We have hand picked the best science podcasts for 2018. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Hacking The Law
We have a vision of justice as blind, impartial, and fair — but in reality, the law often fails those who need it most. This hour, TED speakers explore radical ways to change the legal system. Guests include lawyer and social justice advocate Robin Steinberg, animal rights lawyer Steven Wise, political activist Brett Hennig, and lawyer and social entrepreneur Vivek Maru.
Now Playing: Science for the People

#495 Earth Science in Space
Some worlds are made of sand. Some are made of water. Some are even made of salt. In science fiction and fantasy, planet can be made of whatever you want. But what does that mean for how the planets themselves work? When in doubt, throw an asteroid at it. This is a live show recorded at the 2018 Dragon Con in Atlanta Georgia. Featuring Travor Valle, Mika McKinnon, David Moscato, Scott Harris, and moderated by our own Bethany Brookshire. Note: The sound isn't as good as we'd hoped but we love the guests and the conversation and we wanted to...